Human Cargo (38 page)

As it happened, the committee’s words, though important politically, had already been heeded. Eleven years earlier, in 1973, Amnesty Internationa] had organized a conference on torture. It was held in Paris; to it came interested doctors, lawyers, and researchers from many parts of Europe and North America. Among them was a Danish doctor called Inge Kemp Genefke, who set up the world’s first medical center for the study of torture, in Denmark; others soon followed, in Canada, America, and France. Bit by bit, torture’s insidious legacy was unfolded: by leaving physical scars, deformities, and pain that prolong it far into the future, torture also destroys the mind. Some physical injuries were discovered to be susceptible to treatment, but others were not. Few victims, it was found, had been tortured in only one way; most had known many variations. Listening, recording, analyzing, doctors began to discover how clever torturers had become, tailoring their methods so as to cause most pain and distress while leaving the fewest traces. They learned that while the Turks preferred falaka, beatings on the soles of the feet, the Chileans liked to administer electric shocks. Soon, they came to certain conclusions. Three quarters of people who have been tortured suffer from severe mental consequences, and often these take the form of and are accompanied by extreme physical pain. They discovered, also, that treatment to mitigate the effects of torture is virtually always difficult.

In London lived a medical secretary who had gone into Belsen with the Allies in 1945 as a nineteen-year-old volunteer, and stayed on for two years to work with the survivors, then spent the next seven helping children who had been through Auschwitz. She had long been interested in the aftereffects of horror and grief. Her name was Helen Bamber; she was rather short, with a pretty, innocent
face and a light, soft voice. Volunteering in her spare time for Amnesty International in the 1980s, she set up a medical group to document the stories of refugees arriving in England from countries like Argentina and Greece. Amnesty was a campaigning organization; it could lobby and collect material, but it could not treat. So, in 1985, Helen found the backers and the money to open the Medical Foundation for the Care of Victims of Torture, and when I first met her, she was working in two rooms in the National Temperance Hospital not far from Euston and King’s Cross stations.

Because she believed so passionately in what she was doing, because she is a persuasive and remarkable woman, she was soon a magnet for a whole range of doctors, psychiatrists, and therapists, who came to her after their days in hospitals and clinics to treat, for free, people with dislocated shoulders and disfiguring burns, with agonizing pain in the soles of their feet, and with terrors and flashbacks that stalked them day and night. “The majority of those tortured do not survive,” Helen would tell people who came to hear about the work of the foundation. The testimonies of those who do survive “cast a shadow on us all.” Arthur Koestler, waiting in a prison to be executed during the Spanish Civil War, described himself as so restricted in time and space, so deprived of hope by the imminence of death, that he lacked even the substance to cast a shadow. Helen borrowed his image. The shadows of those who had been tortured, ethereal miasmas of agony and loss, pain so real that it had destroyed the will to live, needed addressing. In her quiet, soft, reasonable voice, Helen would explain how it was our duty, as people who had not suffered this way, to bear witness, to reclaim time and space for those who had lost both, and in the process to counter what she calls the “climate of disbelief” that colors the attitude of the West toward those who seek asylum. The people who came to work with her would document the experiences of those who had been tortured and would help them to live again. The question for Helen, though torture itself is full of nuances and ambiguities, has always been fundamentally simple: how do you coax back to a bearable existence people whose bodies have been attacked,
whose brains and memories have been weakened by blows to the head, whose privacy and pride have been invaded by rape and sexual assault, who have seen their families destroyed and have lost everything that once mattered to them, though they have done nothing wrong? Torture, she would say, is about isolation and chaos, about the disintegration of the psyche. Tortured people have to be helped to reclaim their lives; they have to be freed, not cured, for the concept of cure is seldom appropriate; they have to learn to cope again.

Those she could not immediately see how to heal, those for whom the scars of memory were so deeply embedded that they obscured all possibility of brighter realities, these she would “accompany.” Accompanying, traveling alongside, in Helen’s view, is a crucial part of the process.

When I went to see her, early in 2003, Helen talked about a middle-aged Rwandan woman who had been referred to her not long before. For several weeks, Mrs. M. did not speak. She cried, she rocked, but she said nothing. Helen sat and held her. Week after week, she appeared in Helen’s room, at the appointed time and on the correct day, and cried and rocked. Then one day she began to talk. She said that she was a Hutu, the wife of a Hutu businessman who sold spare parts for cars, and that she had three children, a girl of thirteen and two boys of ten and six. In 1994, some years before the birth of her youngest child, civil war came to her village. One day Tutsi soldiers arrived. They assumed that her family had been responsible for the deaths of Tutsis. They killed her father and her two brothers, with knives and machetes. Then they attacked her, using machetes and bayonets, and slashed her from side to side, almost amputating her right foot, and leaving her stomach and groin with open gashes. They raped her, vaginally and anally. Leaving many villagers dead or mutilated, they dragged her husband away with them. Later, she heard that they were holding him in a prison, and later still he suddenly appeared at home, having escaped. For a while, the family lived quietly, without trouble. But one day the soldiers came back and, finding her husband there, beat him very badly
and took him away with them. Mrs. M. was again raped, by four men. When she fought off a fifth, she was again slashed and beaten. Her husband did not come back; a neighbor told her that he had been killed. One day, a villager came to tell her that the soldiers were on their way to get her. Mrs. M. fled. She hid in the bush, and then with friends, until money was raised to send her abroad. She left her children with her mother.

As Mrs. M. related her story, she told Helen that every day, as she lay on her bed in her lonely hostel room in London, she saw her children sitting near her. They were always there. Talking about the three children of whom she had no news, and had not seen for many months, Mrs. M. cried and rocked. One day, Helen asked her what she said to her children. Did she tell them that she was always with them in her thoughts? Did she tell them what disgusting food she was forced to eat in her hostel? Mrs. M. laughed. It was the first time she had laughed or smiled, in all the weeks she had been coming. And after this, things changed. The two women talked. It was the beginning, a breakthrough. Now Helen hopes that the day will come when Mrs. M. can accept that her children are not with her— and may never be. “But her reality is still that they are sitting on her bed. I cannot destroy that. I can’t delve into her inner world. She wants not to live, but does not know how to die. I can only accompany her.”

Over the years, the Medical Foundation, growing steadily in response to the victims of torturers in Colombia, Sri Lanka, Kosovo, Iraq, Turkey, Zimbabwe, and Liberia, has developed into a loose federation of skills and therapeutic methods, presided over, until her retirement as director in 2003, by Helen Bamber’s accepting and benevolent eye.
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Drawn to the work by their feelings of sympathy and recognition, bringing with them disciplines that range from Freudian analysis to cognitive therapy, clinicians have discovered at the Medical Foundation the freedom to listen and treat as they see
best, feeling their way into methods that owe as much to instinct and common sense as to orthodox medicine. The Foundation is, say its admirers, one of the last bastions of eclectic medicine, in a field that grows more specialized and narrow all the time. While most clinicians accept post-traumatic stress disorder as a useful label with which to arm their clients in their requests for asylum with the Home Office, few regard it as more than a very broad diagnosis. As a recognizable set of symptoms, shared by many people who have been badly tortured, post-traumatic stress disorder provides a therapeutic base from which to start work. But recognizing the symptoms is just a beginning. The damage done by torture, its particular perversion of human relationships and intimate violations, leaves echoes not easily comprehended or dispelled. Listening always for the nuances of the possible, assessing the degree to which confrontation and direction are wise or premature, becomes part of an everyday process in which to the skills of doctor, psychiatrist, and therapist need to be added those of social worker, housing officer, and lawyer, for the needs of refugees are without bounds. For clinicians trained in precise disciplines, the very flexibility and imaginativeness of their work with clients are extremely attractive.

Though not, of course, to everyone. Some years ago, the senior clinician at the Foundation was a psychiatrist called Derek Summer-field. The longer he worked with clients, the more Dr. Summerfield came to feel that his skills as a doctor were less important in dealing with asylum seekers and refugees than his ability to find them homes and work. Torture, he accepted, is a devastating event, and can and does leave dreadful effects. But most people who came to the Foundation seemed to him to process and handle the experience themselves, with extraordinary resilience. What they needed was not medical help, which perpetuated their sense of being victims, but practical assistance in putting their lives on a tolerable footing. To call them ill was to detract from their many social problems. As his impatience with what he saw as the “medicalization” of the problem grew, Dr. Summerfield decided to leave and forge his own path. Though the Medical Foundation felt bruised by months of debate
and discussion, the feeling did not last long. Soon, in the warren of offices and consulting rooms that spread across three buildings in North London, lawyers were taking down initial testimonies and working on submissions to government, physiotherapists were easing the pain of fractured bones, psychiatrists evaluating the effectiveness of different interventions, and therapists guiding clients through the minefields in their minds. To explain about the work of the Foundation, Helen tells this story: A young man from a central American country was sent to her one day, several months after his arrival in England. They started sessions together. He had been profoundly tortured, and been forced to watch others tortured. No one in England, he explained, had been able to imagine the degree of his anguish. Instead, he had found a forest, and there, among the beeches, he would run about and shout and cry. The forest, he said, became his doctor. After some months working with Helen, he told her that the Medical Foundation was now his forest.

In other clinics and counseling rooms, and in some parts of the National Health Service, other doctors, many of whom have done their stints at the Medical Foundation, are attempting to come to grips with the hideous legacies of torture and the long unhappiness of exile. Yet the fact that the Foundation is forced to rely on translators—albeit a team of translators, built up over the years, whose knowledge of the many variations of tortures is enormous—has long troubled some of the specialists, who feel the need for more direct contact. A new center to tackle precisely this question was started in London not long ago, by two women with personal experience of oppression and exile. Josephine Klein is the only daughter of a Polish Jew who fled to Holland at the age of seventeen to escape persecution at home, and who herself became a refugee at the age of thirteen, when the Germans invaded Holland. The family— Josephine, her parents, and her disturbed older brother—fled to England. They had hoped to make their way on to America, but when several convoys lost ships on the crossing, they accepted refuge in a village in the Midlands. England treated Josephine well. All she knew about the country came from
The Scarlet Pimpernel
, and she
was not disappointed. The local authority found her a place in a good school and paid for her uniform; soon, she moved to the top of her class. There followed a successful academic career in psychoanalytic psychotherapy. It was a world in which chaos had been contained and regulated, and she was grateful. Josephine is now in her seventies, a smiling, understanding woman.

In 1993, after she had given a paper at a memorial conference for John Bowlby, the psychologist famous for his work on attachment, a young woman came up to her. Aida Alayarian was an Armenian refugee from Iran, studying for a master’s degree; she needed a supervisor for her dissertation on torture. It was, Josephine says now, as the two women, interrupting each other frequently and affectionately, tell me their story, her day for good deeds. She promised Aida that when she had a vacancy she would accept her as a student, and she kept her word. It took her just three sessions to realize that Aida, who had trained in Iran in clinical psychology and child therapy, needed not a supervisor but a collaborator. As Aida wrote her dissertation about torture, the two women talked about their own lives, about Josephine’s extended family, almost all of whom disappeared into the extermination camps, and about Aida’s escape from Teheran’s notorious Evin prison, and they told each other how they would like to start a treatment center for traumatized refugees, and how they would recruit and train therapists who could work with clients in their own languages, without need of interpreters. Interpreters, however sensitive and good, it seemed to them, inevitably blunted a process almost too fragile for words, and they were appalled when, in the work they were already doing, they noticed that people would bring and use as interpreters their own children, who had learned English quicker than they had been able to, rather than tell their stories through strangers.